RESUMEN
The combination of nasal congestion, rhinorrhea, sore throat, cough, and malaise is the symptomatic profile that constitutes an uncomplicated upper respiratory tract infection (URI), also known as the common cold. Because no known cure exists for a URI, numerous products are available, each marketed with the promise of alleviating the associated symptoms and/or shortening the duration of illness. The evidence supporting these claims is variable and is the focus of this article, with an emphasis on complementary and integrative therapies.
Asunto(s)
Terapias Complementarias/métodos , Medicina Integrativa/métodos , Infecciones del Sistema Respiratorio/terapia , Humanos , Resultado del TratamientoRESUMEN
The National Kidney Foundation's (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) definition of chronic kidney disease (CKD), stages 3-5, requires 2 estimated glomerular filtration rates (eGFRs) <60 ml/min/1.73 m(2) more than 3 months apart. By requiring 2 eGFRs, the NKF definition reduced identification of people without chronic disease, which may have decreased identification of individuals with early CKD, but increased identification of those who ultimately have progression of CKD or require renal replacement therapy (RRT). Our objective was to determine whether 2 eGFR tests were better than 1 eGFR as a predictor of RRT, CKD progression, or death. This retrospective incident cohort study evaluates outcomes in adults with an initial eGFR <60 ml/min/1.73 m(2) and a second eGFR after 90 days by examining a third follow-up eGFR. For the 2086 patients in this study, the mean initial eGFR was 50.7 ml/min/1.73 m(2) and the mean second eGFR was 59.3 ml/min/1.73 m(2). More than 40% of the population (925) did not have CKD based upon their second eGFR. The initial eGFR was the best predictor of the third eGFR. There was no material difference in the ability to predict outcome measures between 1 versus 2 eGFR tests, regardless of eGFR value or associated comorbidities. Identifying patients with CKD is a critical step when beginning to implement population management strategies for those patients. Our findings illustrate some of the trade-offs in strategies inherent in methods that might be used to identify patients with CKD; 1 eGFR will identify patients about 5 months sooner, allowing additional time for nephrologist and other therapeutic intervention, but approximately doubles the population to be managed.
Asunto(s)
Tasa de Filtración Glomerular , Fallo Renal Crónico/fisiopatología , Adulto , Anciano , Área Bajo la Curva , Progresión de la Enfermedad , Femenino , Humanos , Incidencia , Fallo Renal Crónico/mortalidad , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC , Estudios Retrospectivos , Sensibilidad y Especificidad , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: The efficiency of patient safety interventions is not well studied, especially laboratory monitoring for drug therapy. More than one-third of preventable adverse drug events are associated with inadequate monitoring. Current knowledge of decreasing adverse drug events through expanded monitoring programs is lacking. DESIGN: The authors focused on a laboratory monitoring program (above usual practice) of renin-angiotensin system (RAS) agents to prevent adverse events of hyperkalemia and acute renal failure. They used a probabilistic decision model to estimate cost savings and cost effectiveness (at $30,000 and $10,000 per quality-adjusted life-year (QALY)). Costs included the monitoring program, and offsets from reduced care in 3 populations (overall, chronic kidney disease [CKD], and diabetes). MAIN RESULTS: Adverse events were most common in those with CKD. Intervening on all new users or the subset with diabetes was almost never expected to be cost saving (probability <1%). But a monitoring program restricted to patients with CKD was expected to be cost saving (probability = 95%). A strategy that intervened on all patients, or those with diabetes, was never cost effective, (probability <1%). But intervening on patients with CKD was estimated to be cost effective (at either cost-effectiveness threshold) at least 95% of the time in the base case. CONCLUSIONS: The authors' findings illustrate that for laboratory monitoring to be cost effective, the patient population must be at high enough risk of adverse events. Further inquiry into the willingness to pay for patient safety interventions is needed.